Table 1. Reviw of Reported Cases in Japan mmhg 436 g 40 mg/day cm 62.5 kg /130 mmhg 64 / 36

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1 FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF Vol. 31, pp , 2003 FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF /110 mmhg K 1.7 meq/l CK IU/l 409 pg/ml 0.2 ng/ml/h CT 1.5 cm 1.5 cm low density MRI T2 6 K ) ) Table K 3.1 meq/l 35

2 Table 1. Reviw of Reported Cases in Japan mmhg 436 g 40 mg/day cm 62.5 kg /130 mmhg 64 / 36

3 1 Table 2. Laboratory findings on admission Table 3. Endocrine hormones Tbble 4. Endclinological Load Tests Table 2, 3 2 CK 11,000 IU/l 100 %myoglobin 1600 ng/ml K 1.7 meq/l ph B.E ACTH PAC 409 pg/ml 8:00351 pg/ml 20:00 PRA 24 17OHCS 17KS 3 V2-V5 U Table 4 ACTH CRH 0.5 mg 1 mg 2 mg 4 mg 8 mg CT Fig cm low density MRI T1 Fig. 2 T2 Fig. 3 Table 5 37

4 Fig. 1. Abdominal computed tomography showing a tumor with smooth margin in the left adrenal gland (arrow). Fig. 3. Adrenal scintigraphy using 131I-iodomethylnorcholestrol, showed that the tumor in the left adrenal gland is functioning and autonomous (arrow). Fig. 2. Abdominal MRI also showing a tumor with smooth margin in the left adrenal gland (arrow). A) T 1-weighted image mass demonstrated a low signal compared with the liver. B) T 2-weighted image mass demonstrated a high signal compared with the liver. Table 6 KK 220 mmhg 80 mg/day 4 mg/day K 1.7 meq/l K 72 meq/day 31 Fig mm 15 mm 15 mm foamy cell adenoma K K 6 47 pg/ml 0.5 ng/ml/hr 38

5 1 Table 5. Selective Sampling of Adrenal Vein Table 6. Clinical Course Fig. 4. A) Cut section of the tumor in the left adrenal gland (arrow). B) Light microscopic findings showing that the tumor consists of foamy cells (HE stain). Table % 3.1 meq/l % 3 20 % % 2 39

6 down regulation 27, 40, 41) K 25, 13, 14, 18) CT Okawa 24) MRI 3, 20, 42) 42, 43) ) Aoi W, Doi Y, Tasaki S, Matsuoka T, Suzuki S, Hashiba K. Primary aldosteronism aggravated during peripartum period. Jpn Heart J 1978; 19: ) Simizu A, Aoi W, Akahoshi M, Utsunomiya T, Doi Y, Suzuki S, Kuramochi M, Hashiba K. Elevation of plasma rennin activity during pregnancy and rupture of a dissectin aortic aneurysma in a patuent with primary aldostronism. Jpan Heart J 1983; 24: ),,. CPK, ; 51: ),,, ; 17: ),,, ; 9: ),,, ; 1: ), ; 263: ),, ; 36: ),, ; 61: ),,, ; 40: ),,, ; 41: ),,, ; 42: ),,,,,., ; 39 : ),,.,. 1992; 40

7 1 40: ),,, ; 9: ) ; 3878: ) Fujiyama S, Mori Y, Matsubara H, Nagata T, Umeda Y, Mastuda T, Iwasaka T, Inada M. Primary aldosteronism with aldosterone-producig adrenal adenoma in pregnant woman. Intern Med 1999; 38: ) Matsumoto J, Miyake H, Isozaki T, Koshino T, Araki T. Primary aldosteronism in pregnancy. J Nippon Med Sch 2000; 67: ) Nezu M, Miura Y, Noshiro T, et al. Primary Aldosteronism as a cause of severe postpartum hypertension in two women. Am J Obstet Gynecol 2000; 182: ),,,,,,,,, ; 21: ) Okawa T, Asano K, Hashimoto T, et al. Diagnosis and Management of Primary Aldosteronism in pregnancy:case report and review of the literature. Am J perinatol 2002; 19: ) Crane MG, Andes JP,Harris JJ, Slate WG. Primary aldosteronism in pregnancy. Obstet Gynecol 1964; 16: ) Boucher BJ, Mason AS. Conn's syndrome with associated pregnancy. Proc R Soc Med 1965; 58: ) Gordon RD, Fishman LM,Liddle GW. Plasma rennin associated pregnancy. Plasma rennin activity and aldstronism. J Clim Endocrine 1967; 27: ) Biglieri EG, Slaton PE. Pregnancy and primary aldosteronism. J Clin Endocrinol 1967; 27: ) Levy J, Marx GF. Problems related to aldosteronism during cesarean section. Anesthesiology 1971; 34: ) Aloia JF, Beutow G. Malignant hypertension with aldosteronoma producing adenoma. Am J Med Sci 1974; 268: ) Wilson M, Morganti AA, Zervoudakis I, Letcher RL, Romney BM, Von Oeyon P, Papera S, Sealey JE, Laragh JH. Blood pressure, the renin-aldosterone system and sex steroids throughout normal pregnancy. Am J of Med 1980; 68: ) Hammond TG, Buchanan JD, Scoggins BA, Thatche R, Whitworth JA. Primary hyperaldosteronism in pregnancy. Aust N Z J Med 1982; 12: ) Elterman JJ, Hagen GA. Aldostronism in pregnancy. Association with virilization of female offspring. South Med J 1983; 76: ) Merril RH, Dombroski RA, Mackenna JM. Primary hyperaldsteronism during pregnancy. Am J Obstet Gynecol 1984; 150: ) Colton R, Perez GO, Fishman LM. Primary aldsteronism in pregnancy. Am J Obstet Gynecol 1984; 150: ) Lotgering FK, Derkx FMH, Wallenburg HCS. Primay Aldosteronism in pregnancy. Am J Obstet Gynecol 1986; 155: ) Hsueh WA. New insights into the medical management of primary aldosteronism. Hypertension 1986; 8: ) Casper F, Seufert R, Riedmiller H, Bauer H. Primary aldosteronism in pregnancy. Gynakol Rundsch 1990; 30: ) Neerhof MG, Shlossman PA, Poll DS, Lodomirsky A,Weiner S. Idiopathic aldosteronism in pregnancy. Obstet Gynecol 1991; 78: ) Baron F, Sprauve ME, Huddleston JF, Fissher AJ. Diagnostic and surgical treatment of primary aldsteronism in pregnancy. Obstet Gynecol 1995; 86: ) Aboud E, De Swiet M, Gordon H. Primary aldosteronism in pregnancy: Shold it be surgaically?. I J Med Sci 1995; 164; ) Solomom CG, Thiet MP, Moore F, Seely EW. Primary hyperaldosteronism in pregnancy. J Reported Med 1996; 41: ) Webb JC, Bayliss P. Pregnacy complicated by primary aldsteronism. South Med J 1997; 90: ) Thurston H. Vascular angiotensin receptors and their role in blood pressure comtrol.am J Med 1976; 61: ),, ; 53: ).., 41

8 ,,, 2001: ) Knochel JP, Schilen EM. On the mechanism of rhabdomyolysis in potassium depletion. J Clin Invest 1972; 51: Abstract A Case of Primary Aldosteronism, Who had Hypertension During Pregnancy Yasuji Sugano 1, Yukio Yamada 2, Chizuko Iwane 2, Tsukasa Miyazu 2, Kouji Osako 2, Masashi Ishikawa 2, Toshihito Shinagawa 3, Toshio Nakamura 1 and Nobuhiko Saito 4 We report a rare case of a 28-years old woman, who was first diagnosed as gestational toxicosis in early pregnancy stage, and received antihypertensive medication. She delivered a baby boy by cesarean section at 26 weeks' gestation. Three months after delivery, she was admitted to our hospital, and with symptoms of muscle weakness and muscle pain in bilateral lower extremities. Laboratory examination showed hypokalemia (1.7mEq/l), low plasma renin activity (0.2ng/ml/h), higher aldsterone level (409pg/ml), along with hypertension (220/110mmHg). Moreover, the abdominal computed tomography scan and MRI disclosed a mass in the left adrenal region( cm). In adrenal scintigraphy, 131 I was accumulated at the tumor side. We made the diagnosis of primary aldsteronism with adrenal tumor. Laparoscopic adrenalectomy was performed. After that her serum potassium and plasma aldsterone level was returned to normal. Key word: Primary Aldsteronism, pregnancy, hypertension. 1 Division of General Internal Medicine, Department of Internal Medicine 2 Division of metabolism and Endocrinology, Department of Internal Medicine 3 Pathology St Marianna University School of Medicine, Yokohama-City Seibu Hospital, Yasashi-cho, Asahi-ku, Yokohama , Japan 4 Department of Internal Medicine St Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki , Japan 42

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